chapter 2 death

8/11/2019 Chapter 2 Death

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D E A T H


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Complete, permanent and irreversiblecessation of the vital functions.

Somatic or Clinical death

Molecular death


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Difficulties to Diagnosis Somatic

death

Warmness of body

Suspended Animation

Coma due to sedatives or hypnotics-Barbiturates

Hypothermia


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Molecular Death

Death of individuals tissues and cells

Process competes by two to three hoursafter somatic death

Changes in the eye, skin muscles etc.


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What is the importance of death?

Disposal of the dead body

Death certificate

Post-mortem


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Transplantation of organs like:

Liverwithin 15 minutes

Kidney 30-40 minutes

Heart 1 hour


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BrainStem death What is Brainstem death How to diagnose

What is its importance to know

Tests for confirmation of brain-stem death Medico-legal importance suspended

animation

Transplantation of Organs


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Brain Stem

Mid brain

Pons

Medulla

Permanent and irreversiblestoppage offunctions of above areas


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Tests for confirmation of brain-stem death

In coma for more than 6hrs or 24 hrs if

cardiac arrest is the cause

No abnormal decorticate or decerebratepostures should be present


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No spontaneous respiration

No epileptic movements

All brain stem reflexes

Should be absent


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Diagnosis of brain-stem death

Establishment of positive diagnosis ofcoma and its causes

irremediable, structural damage of brain

Trying to remedy it and failing

Correctionlow blood pressure

Correction-Hypoxia

Removal of blood clot


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Brain- stem reflexes

Pupillary reflext Optic Auditory Trigeminal Glossopharyngeal Auditory


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Brainstem death shall not be

considered in :Absence of coma

Child below 5 yrs of age

Coma due to drugs, hypothermia,metabolic disorders and shock


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Sudden Death

Sudden deaths are those which are notpreceded or are of only preceded for a

short time of or with morbid symptoms.

Medicolegally

They raise a suspicion of foul play.


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Causes of Sudden death

Unnatural

Violence

Poisoning

Combination of both

Natural


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Cardiovascular

- Coronary disease

- Congenital heart diseases

- Valvular heart diseases

- Hypertensive heart diseases

-

Infection- Cardiac tamponade

- Aortic aneurysm


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Respiratory

- Pulmonary embolism

- Haemoptysis

- Infections

-

Chronic asthmatics- Anaphylaxis

- Obstruction to air passage


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C.N.S.

- Intra cerebral haemorrhage

- Sub arachnoid haemorrhage

- Cerebral thrombosis

-

Embolism- Infections

- Tumor of brain


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Abdominal

- Haemorrhage in the G.I. tract

- Rupture of abdominal aneurysm

- Liver diseases

- Acute pancreatic bleeding


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- Endocrinal- Adrenal haemorrhage

- Diabetic coma

- Myxoedemic and parathyroid crisis

- Iatrogenic

- Abuse of drugs

- Sudden withdrawal of steroids

- Anesthesia- Mismatched blood transfusion.


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Miscellaneous Bacteriaemic shock

Shock due to fear or emotion

Malaria Special causes in children

Cot death or SIDS

Congenital mental abnormalities Concealed puncture wound.


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Suspended Animation

The condition where the person mayappear to be dead due to the fact that the

vital functions are at such a low level as tobe minimum compatible with life,

The Suspended Animation

Apparent death

As a voluntary Act ( Death Trance)

Hypothermia, Drowning, new born, electshock etc.


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Modes of death

Manners of death

Mechanism of death

Cause of death


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Modes of death

Abnormal physiological state, that existedat the time of death

According to Bichat

Coma Syncope

Asphyxia

Depending upon the involvement of thesystem and irrespective of the remotecause of death.


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Coma Death

Failure of functions brain

Due to paralysis of the vital centers

Compression of brain due to diseases

Injuries to brain

Poisoning to brain-opium, alcohol etc Metabolic disorders- Uraemia


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Death due to syncope

Failure of the function of the heart

Anaemia of the brain

Due to heart disease

Exhausting diseases

Poisons- Digitalis, tobacco, aconite etc.


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death due to Asphyxia

Failure of the function of lungs

Pathological conditions- Pneumonia

Poisoning- Opium

Irrespirable gasesco, co2 etc.

Traumatic Asphyxia- Stampade

Mechanical interference prevention of airentry to respiratory track


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According to Gordon

The functions of vital organs depends onthe availability and utilization of oxygen by

the body tissues -> AnoxiaAnoxic Anoxia

Anaemic Anoxia

Histotoxic Anoxia

Stagnent Anoxia


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Anoxia

Anoxic Anoxia

Mechanical Interference to the passage of air

Closure of the external respiratory orifices Eg. Smothering

Closure of the air passages by external pressure

on the neck Eg. Hanging, Strangulation

Closure by impaction of foreign body closure byfluid- Drowning.


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Prevention of normal movements of thechest

Pressure on the chest- stampade, fall ofmason etc

Injury to chest wall- penetrating injuries

Poisoning- strychnine

Electric shock due to bulbar palsy

Vitiated atmosphere.


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Anaemic Anoxia :

Reduced oxygen carrying capacity of bloodAcute haemorrhage, acute poisoning by co. andnitrites.

Histotoxic Anoxia:

Decreased oxidative process in tissue, tissue

cells are poisonedeg. Cyanide poisoning. Stagnant Anoxia:

In efficient circulation through the tissues- shock. C.C.F. etc.


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The Manner of Death

It is a design or fashion in which thecause of death came into being

If death occurs from some disease, themanner of death is ; Natural

If death occurs due to violence the

manner will be unnatural or violentdeath, may be accidental, suicidal orhomicidal, it depends on circumstances of

the episode.


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The Mechanism of Death

It is a physiological or biochemicaldisturbances- metabolic acidosis, alkalosis,sepsis, toxaemia or paralysis etc.

The Cause of death

Disease or injury

Chain of events Brief or prolonged

Produces fatal outcome.

chapter 2 death

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